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Postpartum emergency contraception — DFSRH MCQ

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HardSpecial CircumstancesPostpartum emergency contraceptionDFSRH

A breastfeeding patient 5 weeks postpartum had unprotected intercourse 36 hours ago. Night feeds are regularly more than 6 hours apart, so lactational-amenorrhoea criteria are not met. She wants oral emergency and ongoing contraception. What is appropriate?

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Correct answer: C — Give LNG-EC now and quick-start a desogestrel POP

The best answer is “Give LNG-EC now and quick-start a desogestrel POP”. Pregnancy risk resumes from day 21 postpartum unless all lactational-amenorrhoea criteria are met. Levonorgestrel emergency contraception is compatible with breastfeeding, and a desogestrel POP can be started immediately afterwards with 2 days of additional precautions. A pregnancy test 21 days after the intercourse is still required because oral emergency contraception is not completely effective.

Reference: CoSRH/FSRH, Contraception After Pregnancy (amended October 2020): https://www.cosrh.org/Common/Uploaded%20files/documents/contraception-after-pregnancy-guideline-oct2020.pdf